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Results for “Systematic Review”

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PubMed2006

Health benefits of weight reduction in postmenopausal women: a systematic review.

The objective of this systematic review was to determine the effect on long-term health outcomes of lifestyle interventions designed to produce weight loss in postmenopausal women. A systematic search of the MEDLINE, EMBASE, PsychINFO and CINAHL databases retrieved four randomized controlled trials (RCTs) and one controlled clinical trial (CCT) of at least 24 weeks' duration as well as one systematic review. The majority of the studies recruited from the community, had samples with similar baseline characteristics and assessed completers only. Drop-out rates varied from 2.5% to 16%. All active-treatment arms demonstrated significant improvements in weight and body composition from baseline. Significant effects between treatment groups were shown only in intervention versus control studies. Significant weight loss was not accompanied by beneficial changes in cardiovascular risk factors in the majority of studies. None of the studies of weight loss reported disease outcomes. Weight loss in active-treatment arms varied from 1.5 kg to 9 kg over 6-12 months. The study that produced the greatest weight loss demonstrated improvements in risk factors and it may be that only this one study produced sufficient weight loss to do so. Many of the studies were probably underpowered and too short in duration to detect change in risk factors. Lifestyle interventions do produce weight loss in overweight postmenopausal women and have the potential to improve disease outcomes associated with overweight.

Body Mass Index↗

PubMed2003

Management of the injured patient: identification of research topics for systematic review using the delphi technique.

BACKGROUND: Systematic reviews of controlled clinical trials in the form of meta-analyses can serve as an important guide to direct clinical practice. This study identifies the most important research questions pertaining to the acute care of the injured patient using a Web-based Delphi technique to achieve consensus of expert opinion. METHODS: Experts in trauma care from the United States and Canada (n = 68) were asked to generate structured research questions and were then required to rank these questions in order of importance and estimate the amount of research currently published. RESULTS: The questions ranking in the highest tertile are presented along with an estimate of their importance and the amount of research published using an ordinal scale. Only 9 of 16 (56%) questions had some or a substantial amount of research available on which to perform a systematic review. CONCLUSION: This study identifies the areas of trauma care in which research efforts might best be directed. In the absence of sufficient data for systematic reviews, these research topics represent important areas for the design and implementation of clinical trials.

Humans↗

PubMed2003

Preventive care in the emergency department: should emergency departments conduct routine HIV screening? a systematic review.

OBJECTIVE: To perform a systematic review of the emergency medicine literature to assess the appropriateness of offering routine HIV screening to patients in the emergency department (ED). METHODS: The systematic review was conducted with the aid of a structured template, a companion explanatory guide, and a grading and methodological scoring system based on published criteria for critical appraisal. Two reviewers conducted independent searches using OvidR, PubMed, MD Consult, and Grateful Med. Relevant abstracts were reviewed; those most pertinent to the stated objective were selected for complete evaluation using the structured template. RESULTS: Fifty-two relevant abstracts were reviewed; of these, nine were selected for detailed evaluation. Seven ED-based prospective cross-sectional seroprevalence studies found HIV rates of 2-17%. Highest rates of infection were seen among patients with behavioral risks such as male homosexual activity and intravenous drug use. Two studies demonstrated feasibility of both standard and rapid HIV testing in the ED, with more than half of the patients approached consenting to testing by either method, consistent with voluntary testing acceptance rates described in other settings. Several cost-benefit analyses lend indirect support for HIV screening in the ED. CONCLUSIONS: Multiple ED-based studies meeting the Centers for Disease Control and Prevention Guideline threshold to recommend routine screening, in conjunction with limited feasibility trials and extrapolation from cost-benefit studies, provide evidence to recommend that EDs offer HIV screening to high-risk patients (i.e., those with identifiable risk factors) or high-risk populations (i.e., those where HIV seroprevelance is at least 1%).

AIDS Serodiagnosis↗

PubMed2006

Follow-up of occult bone lesions detected at MR imaging: systematic review.

PURPOSE: To perform a systematic review of the literature regarding the natural course of posttraumatic occult bone lesions (often referred to as bone bruises) detected at magnetic resonance (MR) imaging. MATERIALS AND METHODS: A systematic review of the literature was performed by searching the MEDLINE database (from January 1966 to February 2003) with the keywords bone bruise, trauma, follow-up, and MRI. Keywords were linked by using the Boolean operator AND. Studies were included if all of the following criteria were fulfilled: patients sustained trauma, MR imaging was used as a diagnostic method, results of clinical or MR imaging follow-up were available, and study was written in English, Dutch, German, French, Spanish, Italian, Swedish, Danish, or Norwegian. The quality of each study was assessed by using a standardized criteria set, and kappa statistics were estimated to rate the level of agreement between the two reviewers. Results were compared with regard to study design and quality scores. RESULTS: The MEDLINE search identified 266 articles, 13 of which met the inclusion criteria. The quality of the included studies was moderate. The two reviewers initially agreed on 179 quality items (kappa = 0.84). The study population was generally small, and follow-up periods ranged from 1 to 73 months. Four different classification systems were used, and in two studies bone bruise was not specified. Study results suggest a generally good clinical prognosis of bone bruises. Normalization of MR imaging appearance is possible and is most often encountered after the occurrence of reticular lesions. Cartilage loss at follow-up is often found in cases of initial cartilage damage (impaction or osteochondral fracture). CONCLUSION: In general, a healing response was often encountered after sustained posttraumatic occult bone lesions. The initial MR imaging appearance appears to have prognostic value.

Ankle Injuries↗

PubMed2006

Diagnostic tests in Hirschsprung disease: a systematic review.

OBJECTIVE: We conducted a systematic review to determine and compare the diagnostic accuracy of contrast enema (CE), anorectal manometry (ARM) and rectal suction biopsy (RSB) in infants suspected of Hirschsprung disease. DESIGN: This is a systematic review. DATA SOURCES: Articles were identified through electronic searches in Medline, EMBASE.com and Cochrane Controlled Trials Register. Searches were limited to articles published after 1966 in PubMed and after 1980 in EMBASE.com. STUDY SELECTION: Studies were included if infants underwent at least one of the following tests: CE, ARM or RSB, followed by full-thickness biopsy and/or clinical follow-up as the reference standard. DATA EXTRACTION: Two reviewers independently assessed the methods of data collection, patient selection, blinding and prevention of verification bias and description of the test protocol and reference standard. Data to construct 2 x 2 tables were abstracted for each test. RESULTS: Twenty-four studies met our inclusion criteria, but 2 studies were subsequently excluded for statistical analysis because data was missing to construct the 2 x 2 table. RSB (14 studies for a total of 993 patients) was the most accurate test, having both the highest mean sensitivity (93%; 95% confidence interval [CI], 88%-95%) and mean specificity (98%; 95% CI, 95%-99%). Sensitivity and specificity of ARM (9 studies for a total of 400 patients) were similar to those of RSB (91% vs 93%, P = 0.73 and 94% vs 98%, P = 0.08, respectively). Sensitivity and specificity of CE (12 studies for a total of 425 patients) were significantly lower than those of RSB and ARM, with mean sensitivity and mean specificity of 70% and 83%, respectively. CONCLUSIONS: RSB and ARM are the most accurate tests in the diagnostic workup of Hirschsprung disease.

Anal Canal↗

PubMed2003

Food prepared in iron cooking pots as an intervention for reducing iron deficiency anaemia in developing countries: a systematic review.

OBJECTIVE: To complete a systematic review of the effect of preparing food cooked in iron pots on haemoglobin concentrations and to assess compliance with pot use. DESIGN AND SEARCH STRATEGY: We searched The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, The Cochrane Controlled trials Register, The Cochrane Methodology Register, Health Technology Assessment Database and NHS Economic Evaluation Database (Cochrane Library, Issue 3, 2002). Medline (1966 to May 2002) and EMBASE (1988 to May 2002). Reference lists of published trials were examined for other potentially relevant trials and authors of selected trials were contacted to obtain information about ongoing or unpublished trials. Selection criteria included randomized trials which compared the effect of food cooked in cast iron pots with food cooked in noncast iron pots on participants of a minimum age of 4 months. One reviewer applied inclusion criteria to potentially relevant trials. Two reviewers assessed trial quality and extracted data. RESULTS: Three trials were eligible for inclusion in the review. There is some evidence from these studies that eating food prepared in iron pots increases the haemoglobin concentration of anaemic/iron deficient individuals. This effect seems to be modified by compliance, users age, and the presence of malaria and hookworm. Compliance with pot use varies considerably between countries depending on several factors, including: size of the cooking pot, targeted user group, whether the pot is used as an extra or replacement pot, and familiarity with cast iron pots. CONCLUSION: The introduction of iron pots or improving their use in communities in developing countries for the preparation of food maybe a promising innovative intervention for reducing iron deficiency and iron deficiency anaemia. Further research is required to monitor the use and effectiveness of this intervention.

Humans↗

PubMed2004

Use of skeletal maturation based on hand-wrist radiographic analysis as a predictor of facial growth: a systematic review.

The purpose of this systematic review was to evaluate the predictive value of hand-wrist radiographic assessment of skeletal maturity in estimating facial growth timing and velocity. A search of PubMed, Medline, Cochrane Database of Systematic Reviews, Embase, Web of Sciences, and Lilacs identified 16 articles that met the following inclusion criteria: use of hand-wrist radiographs for skeletal maturation determination, facial growth evaluated through cephalometric radiographs, and cross-sectional or longitudinal studies. Five articles were rejected because of major methodological issues. Most of the remaining articles had small sample size, and there was no report of randomization or method error. Skeletal maturity determined by hand-wrist radiographic analysis was well related to overall facial growth velocity. Maxillary and mandibular growth velocities were related to skeletal maturity, but their relationship was less robust than that for overall facial growth. The available articles have not adequately defined a relationship between cranial base growth velocity and skeletal maturity. Hand-wrist radiographic assessment of skeletal maturity for use in facial growth prediction should include bone staging as well as ossification events. The role of skeletal maturity assessment in clinical and research applications is discussed and recommendations are provided.

Age Determination by Skeleton↗

PubMed2001

Preventive care in the emergency department: should emergency departments institute a falls prevention program for elder patients? A systematic review.

OBJECTIVE: To perform a systematic review of the emergency medicine literature to assess the appropriateness of an intervention to identify, counsel, and refer emergency department (ED) patients >64 years old who are at high risk for falls. METHODS: The systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. A reference librarian did two PubMed searches using the following: ED visits, patients >64 years old, falls, high risk, and effectiveness of intervention. Emergency Medical Abstracts, Science Citation Index, and the Cochrane Collaboration database were searched. Two team members reviewed the abstracts and selected pertinent articles. References were screened for additional pertinent articles. RESULTS: Twenty-six articles were reviewed. None were ED-based primary or secondary falls prevention in older patients. One randomized controlled trial of an intervention to decrease subsequent falls in elder community-dwelling patients who presented with a fall showed a structured interdisciplinary approach significantly reducing the number of falls. Two ED-based studies showed it was possible to identify ED patients at risk for falls. CONCLUSIONS: Based on one randomized controlled trial demonstrating a significant reduction in the risk of further falls, the burden of suffering caused by falls, and other studies demonstrating the value of interventions to reduce the risk of falling, the authors recommend that EDs conduct research to evaluate the effectiveness of clinical interventions to identify, counsel, and refer ED patients >64 years old who are at high risk for an unintentional fall.

Accidental Falls↗

PubMed2004

[Doubtful evidence for the use of the cholinesterase inhibitor donepezil in patients with dementia--a systematic review].

OBJECTIVE: Objective of this systematic review is to determine the level of scientific evidence for the use of Donepezil in Alzheimer's Disease. METHODS: Ten randomised controlled double-blind trials testing Donepezil versus Placebo were identified in MEDLINE and EMBASE. All ten trials were included in this systematic review. Following a detailed catalogue of criteria the methodological standard of the ten trials was assessed. RESULTS: The authors of eight trials postulated statistically significant differences in favour of Donepezil. Unfortunately, the methodological standard of all studies was insufficient. The methodological shortcomings are discussed in detail. CONCLUSION: With regard to severe methodological deficiencies the evidence for the use of Donepezil in moderate to severe Alzheimer's Disease is lacking. But even if the trials had been conducted in a methodologically correct way the clinical relevance of the postulated positive results would have to be questioned.

Aged↗

PubMed2004

The quality of systematic reviews in dentistry.

DATA SOURCES: Sources of reviews were the Database of Reviews of Effectiveness (DARE) and completed systematic reviews registered by the Cochrane Oral Health Group in the Cochrane Library. STUDY SELECTION: All systematic reviews that examined the effectiveness of interventions for oral, dental and craniofacial disorders and diseases were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS: A quality assessment checklist was completed for each study. RESULTS: A total of 115 studies were identified, of which 65 were relevant to the review. The area most frequently evaluated within the reviews was pain relief or prevention (20 out of 65, ie, 31%) followed by caries, and oral medicine. The quality assessment of the systematic reviews identified highlighted key areas where improvements could be made. One major weakness was that the search strategies employed in reviews were not always adequate: only 12 reviews (19%) demonstrated an attempt to identify all relevant studies. Other areas of weakness include the screening and quality assessment of primary studies, the pooling of data and examination of heterogeneity, and the interpretation of findings. CONCLUSIONS: The quality of systematic reviews in dentistry could be improved. If future clinical decisions are to be based upon systematic reviews, it is imperative that reviews address clinically-relevant, focused questions, and follow a transparent, well-designed protocol.

Comment↗

PubMed2005

Acupuncture in xerostomia--a systematic review.

The aim of this systematic review was to assess the efficacy of acupuncture in the management of xerostomia. Assessing quality of studies aim to efficiently integrate valid information and provide a basis for sound decision making based on the best available evidence. Articles of controlled clinical trials evaluating the efficacy of acupuncture in the management of xerostomia were obtained by searching through the databases MEDLINE and Cochrane Central Register of Controlled Trials to September 2003. Three articles met the criteria for inclusion and a criteria list was used to assess the quality of these studies. The studies were considered to be of high quality or low quality in accordance with the criteria list utilized. The results of the trials were considered positive, negative or indifferent based on statistically significant between group differences. The criteria list utilized indicate that one of the three studies was of high quality and it presents indifferent results. One of the two studies of low quality presents positive results and one presents indifferent results. An analysis of the results degree of evidence resulted in no evidence for the efficacy of acupuncture in the management of xerostomia. This systematic review shows that there is no evidence for the efficacy of acupuncture in the management of xerostomia. There is a need for future high quality randomized controlled trials.

Acupuncture Therapy↗

PubMed2001

Systematic review in diagnostic radiology.

Systematic review (SR) already makes a major contribution to evidence-based healthcare by making the review process transparent and by reducing bias. SR has been successfully applied to observational studies. Radiologists have already begun to make an impact in dentistry by using SR as a decision-making tool. Central to SR is establishment of a research question, selection criteria, a search plan, a literature search, an appraisal of the identified literature by the selection criteria; an analysis and a formulation of recommendations. With regard to the literature search, electronic databases (Medline, Embase, Science Citation Index, Lilacs), controlled subject headings, exploding and free-text searching, handsearching and the gray literature are discussed.

Databases, Bibliographic↗

PubMed2007

Osteoporosis-related kyphosis and impairments in pulmonary function: a systematic review.

UNLABELLED: We conducted a systematic review to examine the relationship between osteoporotic vertebral fractures, kyphosis, and pulmonary function. Findings suggest modest but predictable declines in vital capacity related to the degree of kyphosis. However, there were only four studies, and all had significant methodologic limitations. Further high-quality research is needed. INTRODUCTION: Our objective was to systematically review the extent to which osteoporosis-related vertebral fractures and kyphosis affect pulmonary function. MATERIALS AND METHODS: We used a literature search from 1966 to 2006 (using Medline, EMBASE, and hand searches of references) for studies examining pulmonary function in patients without known lung disease who had vertebral fractures or kyphosis secondary to osteoporosis. Two reviewers independently abstracted data. Heterogeneity precluded formal meta-analysis. RESULTS: Initial searches yielded 453 articles. After applying eligibility criteria, only four case-control studies of limited quality (e.g., only one study was blinded) remained. Since 1966, only 109 patients (6 men) have been studied. All four studies reported reductions in vital capacity (VC), with values ranging from 68% to 94% of predicted values. This was quantified as a 9% reduction in predicted VC per vertebral fracture in one study. The degree of kyphosis clinically (one study) or radiographically (three studies) correlated with declines in VC; impairments were most notable at kyphotic angles>55 degrees. Statistically significant differences in percent predicted VC were obtained only when arm span or recalled height, rather than measured height, was used (two studies). CONCLUSIONS: Despite conventional teaching, the evidence relating osteoporotic vertebral fractures or kyphosis to pulmonary function is limited. On the basis of available studies, declines in VC secondary to kyphosis seem modest and directly related to the number of vertebral fractures or degree of kyphosis. Future studies need longitudinal follow-up of larger numbers of men and women, appropriate proxies for height, standardized measures for pulmonary function and kyphosis, and efforts to blind outcomes ascertainment.

Female↗

PubMed2005

The librarian's roles in the systematic review process: a case study.

UNLABELLED: QUESTION/SETTING: Although the systematic review has become a research standard, little information addresses the actions of the librarian on a systematic review team. METHOD: This article is an observational case study that chronicles a librarian's required involvement, skills, and responsibilities in each stage of a real-life systematic review. MAIN RESULTS: Examining the review process reveals that the librarian's multiple roles as an expert searcher, organizer, and analyzer form an integral part of the Cochrane Collaboration's criteria for conducting systematic reviews. Moreover, the responsibilities of the expert searcher directly reflect the key skills and knowledge depicted in the "Definition of Expert Searching" section of the Medical Library Association's policy statement, "Role of Expert Searching in Health Sciences Libraries." CONCLUSION: Although the librarian's multiple roles are important in all forms of medical research, they are crucial in a systematic review. As an expert searcher, the librarian must interact with the investigators to develop the terms required for a comprehensive search strategy in multiple appropriate sources. As an organizer and analyzer, the librarian must effectively manage the articles and document the search, retrieval, and archival processes.

Humans↗

PubMed2000

Exercise therapy for low back pain: a systematic review within the framework of the cochrane collaboration back review group.

STUDY DESIGN: A systematic review of randomized controlled trials was performed. SUMMARY OF BACKGROUND DATA: Exercise therapy is a widely used treatment for low back pain. OBJECTIVES: To evaluate the effectiveness of exercise therapy for low back pain with regard to pain intensity, functional status, overall improvement, and return to work. METHODS: The Cochrane Controlled Trials Register, Medline, Embase, PsycLIT, and reference lists of articles were searched. Randomized trials testing all types of exercise therapy for subjects with nonspecific low back pain with or without radiation into the legs were included. Two reviewers independently extracted data and assessed trial quality. Because trials were considered heterogeneous with regard to study populations, interventions, and outcomes, it was decided not to perform a meta-analysis, but to summarize the results using a rating system of four levels of evidence: strong, moderate, limited, or none. RESULTS: In this review, 39 trials were identified. There is strong evidence that exercise therapy is not more effective for acute low back pain than inactive or other active treatments with which it has been compared. There is conflicting evidence on the effectiveness of exercise therapy compared with inactive treatments for chronic low back pain. Exercise therapy was more effective than usual care by the general practitioner and just as effective as conventional physiotherapy for chronic low back pain. CONCLUSIONS: The evidence summarized in this systematic review does not indicate that specific exercises are effective for the treatment of acute low back pain. Exercises may be helpful for patients with chronic low back pain to increase return to normal daily activities and work.

Exercise Therapy↗

PubMed1999

The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVES: To evaluate the efficacy and effectiveness of acupuncture for the management of nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Acupuncture is one of the oldest forms of therapy, but little is known about the effectiveness of acupuncture for low back pain. METHODS: Randomized controlled trials were done to assess the effectiveness of all types of acupuncture treatment, which involves needling for subjects with nonspecific low back pain. Two reviewers blinded with respect to authors, institution, and journal independently assessed the methodologic quality of the studies. Because data were statistically and clinically too heterogeneous, a qualitative review was performed. The evidence was classified into four levels: strong, moderate, limited, or no evidence. RESULTS: Eleven randomized controlled trials were included. Overall, the methodologic quality was low. Only two studies met the preset "high quality" level for this review. No study clearly evaluated acupuncture for acute low back pain. The results indicate that there was no evidence showing acupuncture to be more effective than no treatment. There was moderate evidence indicating that acupuncture is not more effective than trigger-point injection or transcutaneous electrical nerve stimulation, and there was limited evidence that acupuncture is not more effective than placebo or sham acupuncture for the management of chronic low back pain. CONCLUSIONS: Because this systematic review did not clearly indicate that acupuncture is effective in the management of back pain, the authors would not recommend acupuncture as a regular treatment for patients with low back pain. There clearly is a need for more high-quality randomized controlled trials.

Acupuncture Analgesia↗

PubMed2005

Assessment of methodological quality of primary studies by systematic reviews: results of the metaquality cross sectional study.

OBJECTIVES: To describe how the methodological quality of primary studies is assessed in systematic reviews and whether the quality assessment is taken into account in the interpretation of results. DATA SOURCES: Cochrane systematic reviews and systematic reviews in paper based journals. STUDY SELECTION: 965 systematic reviews (809 Cochrane reviews and 156 paper based reviews) published between 1995 and 2002. DATA SYNTHESIS: The methodological quality of primary studies was assessed in 854 of the 965 systematic reviews (88.5%). This occurred more often in Cochrane reviews than in paper based reviews (93.9% v 60.3%, P < 0.0001). Overall, only 496 (51.4%) used the quality assessment in the analysis and interpretation of the results or in their discussion, with no significant differences between Cochrane reviews and paper based reviews (52% v 49%, P = 0.58). The tools and methods used for quality assessment varied widely. CONCLUSIONS: Cochrane reviews fared better than systematic reviews published in paper based journals in terms of assessment of methodological quality of primary studies, although they both largely failed to take it into account in the interpretation of results. Methods for assessment of methodological quality by systematic reviews are still in their infancy and there is substantial room for improvement.

Cross-Sectional Studies↗

PubMed2001

Tissue plasminogen activator for the treatment of deep venous thrombosis of the lower extremity: a systematic review.

OBJECTIVE: To assess, by systematic review, the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) in the treatment of lower extremity deep venous thrombosis (DVT). A secondary objective is to assess the optimal dose and route of administration of rt-PA. METHODS: Included studies were randomized, controlled trials comparing rt-PA plus unfractionated heparin (UFH) to UFH alone, rt-PA at different doses, or rt-PA by different routes of administration in the treatment of DVT. Outcomes had to be described in terms of percent change in venographic patency for efficacy (>50% lysis) and in sufficient detail for complications (major and minor hemorrhages and other). The search strategy included searching electronic databases and contacting pharmaceutical agencies and content experts. Study quality was assessed using the Jadad scale. A threshold quality score was used to exclude trials. RESULTS: Five studies met the following inclusion criteria: three comparing rt-PA plus UFH vs UFH alone (180 patients); one comparing high-dose vs low-dose rt-PA (32 patients); and one comparing systemic vs local administration of rt-PA (151 patients). In studies comparing rt-PA vs placebo, patients assigned to rt-PA were more likely to have > 50% lysis and complications (summary odds ratios [OR], 11.7; 95% confidence interval [CI], 2.61 to 52.5; and OR, 9.95; 95% CI, 2.21 to 44.7, respectively). Major and intracerebral hemorrhages were not significantly increased. One study comparing different doses demonstrated that high-dose and low-dose rt-PA were equally efficacious (OR, 0.88; 95% CI, 0.05 to 14.78). Local rt-PA was neither more efficacious nor riskier than systemic rt-PA. CONCLUSION: This systematic review does not support routine use of rt-PA for DVT.

Anticoagulants↗